Stable Angina Flashcards
What is Angina due to?
Narrowing of the coronary arteries due to atherosclerosis causes reduced blood flow to the myocardium
How many classes of angina are there?
Four
What is class 1 of Angina?
Only on strenuous or prolonged physical activity
What is class 2 of Angina?
slight limitation, with angina only during vigorous physical activity
What is class 3 of Angina?
Symptoms with everyday living activities
What is class 4 of Angina?
Inability to perform any activity without angina or angina at rest i.e. unstable angina
What is the Gold standard for the diagnosis of Angina?
CT Coronary Angiography
What is a CT Coronary Angiography?
Injecting contrast and taking CT images timed with the heart beat, highlighting any narrowing.
What other investigations should you carry out for Angina?
ECG
Echocardiogram
Exercise stress tests with a ECG
What are the 3 aims of treatment?
Immediate symptomatic relief
Long term symptomatic relief
Secondary prevention of cardiovascular disease
What is administered for immediate symptomatic relief?
GTN spray
What does GTN spray cause?
Vasodilation
Helps relieves the symptoms.
How should GTN spray be administered?
Take GTN, then repeat after 5 minutes.
If there is still pain 5 minutes after the repeat dose – call an ambulance.
What is given for long term symptomatic relief?
Beta-blockers
Calcium channel blockers (CCB’s)
What is given for secondary prevention of cardiovascular disease?
Beta-blockers
Calcium channel blockers (CCB’s)
Which and what does of Beta blocker is given?
Bisoprolol
5mg daily
Which and what dose of calcium channel blocker is given?
Amlodipine
5mg daily
What is the possible surgical management of Angina?
PCI
CABG
Which drugs are commonly given for secondary prevention?
Aspirin (i.e. 75mg once daily)
Atorvastatin 80mg once daily
ACE inhibitor
What are other possible drugs for angina that are not first line?
Long acting nitrates (e.g. isosorbide mononitrate)
Ivabradine
Nicorandil
Ranolazine
If angina is stable, what is it always relieved by?
Rest or GTN
When would angina be considered as unstable?
If the symptoms were occurring at rest
Where is the site of anginal pain?
Retrosternal
What is the character of anginal pain?
Tight band
Pressure
Heaviness
Where does anginal pain radiate to?
Jaw
Neck
Arms
What aggravates anginal pain?
Exertion
Emotional distress
Cold weather
Heavy meals
What are relieving factors of angina?
Rest
GTN
How is angina graded?
CCS (canadian cardiovascular scale)
What happens to the heart muscle as a result of angina?
Ischaemia occurs when myocardial oxygen demand is greater than supply
Atherosclerotic plaques narrow the lumen of the coronary arteries
What is stable angina?
When symptoms of angina are always relieved by rest and GTN spray
What is unstable angina?
When symptoms come on randomly whilst at rest
What is the most common cause of angina?
Atheroma
What are non-modifiable RF for angina?
- age
- male gender
- family history of ischaemic heart disease
What is the first line long term treatment for stable angina?
Monotherapy of CCB or BB
What are the 2 main side effects of GTN?
Headaches
Dizziness
If a CCB is being used as montherapy, which drugs should be used?
Verapamil or diltiazem
What is the problem with verapamil and diltiazem?
Avoided in heart failure with reduced ejection fraction
If using a CCB in combination with a BB, which CCB should be used?
Amlodipine
if a patient is on monotherapy and cannot tolerate the addition of a calcium channel blocker or a beta-blocker, which medications can be offered?
Long-acting nitrates (e.g., isosorbide mononitrate)
Ivabradine
Nicorandil
Ranolazine
If a patient is taking both a CCB and a BB and still having symptoms, what can be added?
Long-acting nitrates (e.g., isosorbide mononitrate)
Ivabradine
Nicorandil
Ranolazine
How long should patients be taking 3 drugs for angina?
Whilst a patient is awaiting assessment for PCI or CABG
What interventions can be offered for angina?
PCI
CABG
What is the problem of prescribing verapamil and a beta blocker together?
Complete heart block
